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PubMed1986

Simulation procedures for teaching independent menstrual care to mentally retarded persons.

Four mentally retarded adolescent females participated in a program for assessment and training of independent menstrual care skills. Three task analyses served as the basis for instruction: (a) menstrual stain on underwear, (b) menstrual stain on a sanitary pad, and (c) menstrual stain on both sanitary pad and underwear. During individual training sessions, subjects were taught to perform correct sequences via simulation training with a small doll, in which a trainer utilized instructions, praise, modeling, and corrective feedback. Three types of assessment probes were conducted prior to training, upon completion of specified mastery criteria, and during post-training follow-up sessions. Doll probes assessed performance with the toy doll, self-probes assessed naturalistic performance but under conditions of simulated menstruation, and in vivo probes assessed performance during actual menstruation. Results of a multiple baseline analysis indicated that subjects emitted few correct responses during baseline probes, but showed consistent improvements that corresponded to the introduction of training. Generalization to untrained skills was noted with all subjects. Follow-up assessments indicated maintenance of skills for periods up to 30 weeks following termination of training.

Activities of Daily Living↗
PubMed2006

Evolution of endoscopy simulators and their application.

Significant advances already have been made in the use of simulators for teaching and training in GI endoscopy. Indeed, during the past decade the evolution and improvement of these devices is readily apparent with each passing year. Doubtless, these advances have led to the increased availability and popularity of simulator-based hands-on workshops. Simulator-based skills assessment remains a relatively undeveloped field, awaiting increased realism and the development and validation of proper tests. Still, static models, ex vivo artificial models, ex vivo animal models, and computer simulators collectively represent a substantial and powerful tool for education and training in GI endoscopy. It is easy to foresee a day when hands-on training using simulators will be readily available outside the gastroenterology fellowship setting. With the progression of technology and the continuous introduction of new devices and procedures will come a parallel, compelling need for hands-on, simulator-based experience with all such new tools and techniques.

Animals↗
PubMed2003

Training with an upper-limb prosthetic simulator to enhance transfer of skill across limbs.

OBJECTIVE: To examine what effect bilateral transfer of movement across limbs may have in a person's ability to learn use of an upper-limb prosthetic simulator. DESIGN: Randomized trial. SETTING: University laboratory. PARTICIPANTS: Able-bodied subjects randomly assigned to 1 of 3 groups. INTERVENTIONS: Subjects performed 3 different tasks that required manipulation of objects with the simulator. Group 1 practiced with the simulator on the preferred limb and then transferred it to the nonpreferred limb; group 2 practiced with the simulator on the nonpreferred limb and then transferred it to the preferred limb; group 3 was a control group. Groups 1 and 2 underwent pretest trials, acquisition practice, posttest trials, and a 24-hour retention test; the control group followed the same design with the exception of acquisition practice. MAIN OUTCOME MEASURES: Elapsed time (1) from a signal to move until movement began (initiation time) and (2) from the beginning of movement to task completion (movement time). RESULTS: Compared with the controls, groups 1 and 2 significantly reduced initiation time across all tasks from pretest to posttest (P=.003) and from pretest to retention test (P=.029). Groups 1 and 2 did not differ from each other. Movement time did not differ among the groups in the posttest. However, groups 1 and 2 significantly (P=.026) reduced movement time across all tasks from pretest to retention test compared with the control group. Groups 1 and 2 did not differ from each other. CONCLUSION: The effects of bilateral transfer were evident for initiation time immediately on transfer, and this learning effect persisted to the retention test. The ability to execute movement, represented by movement time, occurred after consolidation of learning was complete. Cross-limb training with a prosthetic simulator may be useful for persons with recent unilateral upper-extremity amputation who are learning to use a prosthesis.

Adult↗
PubMed1996

Effects of semprex-D and diphenhydramine on learning in young adults with seasonal allergic rhinitis.

OBJECTIVES: The purpose of this study was to test the hypothesis that learning ability is impaired in patients with seasonal allergic rhinitis relative to untreated individuals and to evaluate a combination compound (acrivastine 8 mg + pseudoephedrine 60 mg) for attenuation of the learning impairment in these patients. BACKGROUND: In a previous study employing the same method it was shown that young children (10 to 12 yrs) suffering from seasonal allergic rhinitis performed significantly worse on tests of learning and using knowledge after acute treatment with a sedating antihistamine (diphenhydramine 50 mg) or placebo as compared with nontreated healthy controls. This effect was partially reversed by treatment with loratadine. METHODS: Sixty-seven young adults suffering from seasonal allergic rhinitis and 28 matched controls were trained on didactic simulation for three consecutive days. Atopic subjects were treated differentially during training according to a double-blind, randomized, parallel group design with either diphenhydramine hydrochloride 50 mg, a combination compound (acrivastine 8 mg + pseudoephedrine 60 mg, A + P), or placebo, administered qd. After training, all atopic subjects were maintained on A + P treatment for 14 days at which time all groups returned for examination. RESULTS: Mean performance at the end of training was worse for all atopic subjects combined compared with normal subjects. Subjects treated with diphenhydramine performed significantly worse than either normals (P < .001) or those treated with A + P (P < .001). At the examination, the diphenhydramine group's performance differed significantly from those of the normal (P < .001) and A + P groups (P < .001). CONCLUSION: The study supports our previous finding that allergy symptoms reduce learning ability which is further reduced learning ability which is further reduced by diphenhydramine. Atopic subjects with allergies treated with acrivastine + pseudoephedrine learned as well as normal subjects.

Adolescent↗
PubMed2004

[Simulation--an efficient way of learning in graduate and continuous medical education].

BACKGROUND: Different types of simulators and simulated situations are being used in the training of doctors. Even though simulation as a learning method has been used in various areas such as aviation and oil industry, it has only recently been applied to medical education. Simulation seems to be very well suited in training for and building skills and experience with life threatening situation that are seldom seen. It represents no risk to the patient and it opens up for training in realistic scenarios. METHODS: Simulations are illustrated by using Miller's learning pyramid and Bloom's cognitive levels to show how different types of simulation can be used depending on the skills that are to be acquired. Team simulation is seen as a main factor for quality improvement in medicine. INTERPRETATION: Simulation and team simulation in particular is highly rated by participating professionals. There seems to be a problem in finding objective criteria for assessing the simulated scenarios and then to generalise the findings to real situations.

Clinical Competence↗
PubMed1984

Proliferation of motor end-plates induced by increased muscular activity.

The effects of muscular activity on the motor end-plates were studied. To simulate an overload training on the diaphragm, Japanese waltzer mice were subjected to hypobaric hypoxia (simulated altitude of 3000 m) for 7 and 14 days. After demonstration of the end-plates by AChE-staining, their size and total number in the sternal part of the diaphragm were measured at the light microscopic level. The end-plate regions were enlarged after 7 days and were increased in number after 14 days. These changes can probably be explained by the mechanisms of terminal and collateral sprouting. The electron-microscopic examination showed no ultrastructural peculiarities in either of the experimental groups. The muscle fibers of the trained animals showed a strong reaction of AChE; thus, it was suggested that end-plate proliferation was myogenically induced.

Animals↗
PubMedDate not supplied

The correlation grid: analysis of synchronous spiking in multi-dimensional spike train data and identification of feasible connection architectures.

This paper presents a visualization technique specifically designed to support the analysis of synchronous firings in multiple, simultaneously recorded, spike trains. This technique, called the correlation grid, enables investigators to identify groups of spike trains, where each pair of spike trains has a high probability of generating spikes approximately simultaneously or within a constant time shift. Moreover, the correlation grid was developed to help solve the following reverse problem: identification of the connection architecture between spike train generating units, which may produce a spike train dataset similar to the one under analysis. To demonstrate the efficacy of this approach, results are presented from a study of three simulated, noisy, spike train datasets. The parameters of the simulated neurons were chosen to reflect the typical characteristics of cortical pyramidal neurons. The schemes of neuronal connections were not known to the analysts. Nevertheless, the correlation grid enabled the analysts to find the correct connection architecture for each of these three data sets.

Action Potentials↗
PubMed2004

Reliability and validity of the Toowoomba adult trauma triage tool: a Queensland, Australia study.

INTRODUCTION: In Australia a nationally adopted five tiered triage scale called the Australasian triage scale (ATS) is used for the purpose of differentiating patient acuity levels for all patients that present to an emergency department (ED). The scale was formulated with the aim of promoting a standardized approach to triage. Numerous studies now suggest that the ATS has not been successful in achieving this intention. The Toowoomba adult trauma triage tool (TATTT) seeks to address this deficiency by providing an evidence based, reproducible, reliable and valid method of triage categorisation, albeit in a select group of patients. METHOD: Ten triage nurses from Toowoomba health service (THS) and five from Princess Alexandra Hospital in Queensland, Australia were enrolled in the study. Each participant rated five written simulations before receiving training in the TATTT. Each participant then rated nine written scenarios, five simulated scenarios on video and one computer simulated scenario with the TATTT. Parallel triaging of actual adult injury based presentations to THS ED was also undertaken. RESULTS: The overall percentage agreement for all simulations for which data were available was 87%. The overall kappa statistic was 0.82 with a 95% confidence interval from 0.76 to 0.88. The overall percentage agreement between the triage category assigned using existing triage practices and the triage category assigned by the TATTT was approximately 47% with an estimated kappa of kappa(') = 0.19 (95% confidence interval [-0.02,0.40]). CONCLUSION: Evidence from this study suggests that the TATTT provides systematically different results compared to current triage practices utilising the ATS. This provided evidence that triage practices did not reflect current evidence or available descriptors. Additionally TATTT has greater reliability than current triage practices.

Adult↗
PubMed2002

Virtual reality flexible cystoscopy: a validation study.

OBJECTIVES: To validate a flexible cystoscopy simulator by determining if it could differentiate between expert and novice cystoscopists. SUBJECTS AND METHODS: Seventeen subjects (10 novices with no previous endoscopic experience and seven urologists who had all carried out > 1000 flexible cystoscopies each) were asked to undertake a flexible cystoscopy task on the URO Mentor (Simbionix, Israel) virtual reality (VR) machine. In the task used the bladder mucosa has 10 flags (numbered 1-10) at key positions in the bladder; by visualizing each of the 10 flags and photographing them the subject will have indirectly visualized the entire mucosa. Subjects were asked to carry out the task 10 times, to allow their rate of acquisition of skill to be assessed. The total time taken for the task and the number of flags visualized were used as measures of performance. RESULTS: The experienced urologists were significantly better at flexible cystoscopy than the medical students on the first trial for the mean number of flags seen (9.57 vs 8.0, P = 0.01) and the mean time to complete the task (2.33 vs 4.89 min, P = 0.03). At the 10th trial there was still a significant difference for the time taken, between the medical students and the urologists (2.33 vs 0.81 min, P = 0.01) but not for the number of flags seen (9.2 vs 9.6, P = 0.46). The medical students improved between the first and the 10th attempt, being significantly quicker for trial 10 than trial 1 (P = 0.005). However, although the medical students appeared to see more flags (8.0 vs 9.2) this was not significant (P = 0.05). The urologists did not differ in the number of flags visualized between the first and 10th trial, although they were significantly quicker in completing the task (P = 0.02). The urologists were significantly faster in trial 2 than trial 1, but no faster thereafter (P = 0.04). CONCLUSIONS: Using the URO Mentor simulator, it was possible to assess the level of experience of flexible cystoscopy, and therefore the system has construct validity. As in the real situation there is a period of learning during which the subject becomes familiar with the computer/machine/human interface, the task and the handling of the instruments. These results support the view that there is a role for VR simulators in urological training.

Clinical Competence↗
PubMed1992

Effects of job-simulated flexibility and strength-flexibility training protocols on maintenance employees engaged in manual handling operations.

This study examined the effects of four flexibility and strength-flexibility training protocols on the dynamic strength, endurance time, and truncal flexibility of 24 maintenance employees engaged in manual material handling operations. The study was conducted over an 8-week period. Significant improvement in physical capacity was obtained through flexibility training either by a progressive increase in the holding time with fixed exercise repetition or a progressive increase repetition with fixed holding time. The flexibility and strength-flexibility training protocols exhibited similar effects on physical capacity. It was suggested that a follow-up flexibility protocol should be performed on a daily basis in order to maintain the gains obtained in flexibility during the intensive/short training programme.

Adult↗
PubMed2005

A physiologically based, recirculatory model of the kinetics and dynamics of propofol in man.

BACKGROUND: The disposition of propofol in man is commonly described using a three-compartment mamillary model. However, these models do not incorporate blood flows as parameters. This complicates the representation of the changes in blood flows that may occur in surgical patients. In contrast, complex physiologically based models are derived from data sets (e.g., tissue:blood partition coefficients) that may not be readily collected in man. METHODS: Alternatively, the authors report a recirculatory model of propofol disposition in a "standard" man that incorporates detailed descriptions of the lungs and brain, but with a lumped description of the remainder of the body. The model was parameterized from data in the literature using a "meta-modeling" approach. The first-pass passage of propofol through the venous vasculature and the lungs was a function of the injected drug mixing with cardiac output and passing through a three-"tank in series" model for the lungs. The brain was represented as a two-compartment model defined by cerebral blood flow and a permeability term. The Bispectral Index was a linear function of the mean brain concentration. The remainder of the body was represented by compartment systems for the liver, fast distribution and slow distribution. RESULTS: The model was a good fit of the data and was able to predict other data not used in the development of the model. CONCLUSIONS: The model may ultimately find a role in improving the fidelity of patient simulators currently used to train anesthetists and for clinical practice simulation to optimize dosing and management strategies.

Adult↗
PubMed2002

Living high-training low increases hypoxic ventilatory response of well-trained endurance athletes.

This study determined whether "living high-training low" (LHTL)-simulated altitude exposure increased the hypoxic ventilatory response (HVR) in well-trained endurance athletes. Thirty-three cyclists/triathletes were divided into three groups: 20 consecutive nights of hypoxic exposure (LHTLc, n = 12), 20 nights of intermittent hypoxic exposure (four 5-night blocks of hypoxia, each interspersed with 2 nights of normoxia, LHTLi, n = 10), or control (Con, n = 11). LHTLc and LHTLi slept 8-10 h/day overnight in normobaric hypoxia (approximately 2,650 m); Con slept under ambient conditions (600 m). Resting, isocapnic HVR (DeltaVE/DeltaSp(O(2)), where VE is minute ventilation and Sp(O(2)) is blood O(2) saturation) was measured in normoxia before hypoxia (Pre), after 1, 3, 10, and 15 nights of exposure (N1, N3, N10, and N15, respectively), and 2 nights after the exposure night 20 (Post). Before each HVR test, end-tidal PCO(2) (PET(CO(2))) and VE were measured during room air breathing at rest. HVR (l. min(-1). %(-1)) was higher (P < 0.05) in LHTLc than in Con at N1 (0.56 +/- 0.32 vs. 0.28 +/- 0.16), N3 (0.69 +/- 0.30 vs. 0.36 +/- 0.24), N10 (0.79 +/- 0.36 vs. 0.34 +/- 0.14), N15 (1.00 +/- 0.38 vs. 0.36 +/- 0.23), and Post (0.79 +/- 0.37 vs. 0.36 +/- 0.26). HVR at N15 was higher (P < 0.05) in LHTLi (0.67 +/- 0.33) than in Con and in LHTLc than in LHTLi. PET(CO(2)) was depressed in LHTLc and LHTLi compared with Con at all points after hypoxia (P < 0.05). No significant differences were observed for VE at any point. We conclude that LHTL increases HVR in endurance athletes in a time-dependent manner and decreases PET(CO(2)) in normoxia, without change in VE. Thus endurance athletes sleeping in mild hypoxia may experience changes to the respiratory control system.

Acclimatization↗
PubMed2005

Simulation center uses real-world training.

--Students, hospital staff, and faculty all participate in training sessions. --Facility provides ability to train and learn without harm to patients. --Scenarios can be created with specific learning in mind.

Florida↗